Provider Demographics
NPI:1396906780
Name:ROBERT B. HARRISON DMD MSD PLLC
Entity type:Organization
Organization Name:ROBERT B. HARRISON DMD MSD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSD
Authorized Official - Phone:252-633-0424
Mailing Address - Street 1:700 MCCARTHY BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-5233
Mailing Address - Country:US
Mailing Address - Phone:252-633-0424
Mailing Address - Fax:252-638-6662
Practice Address - Street 1:700 MCCARTHY BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5233
Practice Address - Country:US
Practice Address - Phone:252-633-0424
Practice Address - Fax:252-638-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40471223P0221X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC423243OtherUNITED CONCORDIA
NC91755OtherBLUE CROSS BLUE SHIELD
NC8991755Medicaid